Long-term use of temozolomide: could you use temozolomide safely for life in gliomas?

Temozolomide (TMZ) is an alkylating agent used in the management of gliomas. Although TMZ is generally safe and acute toxicity is well documented, there are limited data on long-term toxicities. We present three patients with glioma; all patients started on TMZ after having progressed following primary treatment. These patients have continued TMZ for 5 years, 7 years and 8 years respectively. So far they have had no serious side effects. We discuss these patients while raising the question of prolonged TMZ use.